Hypertension in Diabetic Nephropathy: Epidemiology, Mechanisms, and Management

被引:150
作者
Van Buren, Peter N. [1 ]
Toto, Robert [1 ]
机构
[1] Univ Texas SW Med Ctr Dallas, Div Nephrol, Dept Internal Med, Dallas, TX 75390 USA
关键词
Hypertension; Diabetic nephropathy; CKD; Angiotensin II; Albuminuria; RENIN-ANGIOTENSIN SYSTEM; INCREASES VASCULAR SUPEROXIDE; CONVERTING-ENZYME-INHIBITION; II RECEPTOR BLOCKADE; STAGE RENAL-DISEASE; BLOOD-PRESSURE; ASYMMETRIC DIMETHYLARGININE; OXIDATIVE STRESS; ACE-INHIBITION; NITRIC-OXIDE;
D O I
10.1053/j.ackd.2010.10.003
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Hypertension is highly prevalent in patients with diabetic nephropathy. Diabetic nephropathy is the leading cause of CKD and end-stage kidney disease in the United States. The etiology of hypertension in diabetic nephropathy involves mechanisms with multiple inter-related mediators that result in renal sodium reabsorption and peripheral vasoconstriction. The management of hypertension in these patients is focused on treatments that target these mediators. Clinical trials have established that drugs that inhibit the renin-angiotensin-aldosterone system should be used as first-line agents on the basis of their ability to slow down progression of kidney disease and lower albuminuria. There is further interest into how the combination of drugs that inhibit this pathway at multiple steps will contribute further to the management of hypertension and diabetic nephropathy. This article presents an updated review of the mechanisms involved in hypertension in patients with diabetic nephropathy. It also reviews the past clinical trials using single agents as therapeutics and the more recent trials involving novel drugs or drug combinations used to treat these patients. Retrospective analyses of multiple studies are included to better examine the significance of the currently proposed blood pressure targets for patients with diabetic nephropathy. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.
引用
收藏
页码:28 / 41
页数:14
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